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You have been seeing Natalee Williams for about a year. She comes in today with her mother, Trina, as usual for a regular appointment. Now 11, she originally came in with reports of depression and irritability, including a rapid decline in her schoolwork. You diagnosed her with depression, and she has been taking fluoxetine (Prozac) 20 mg by mouth every day for the past 12 months. Since you last saw her two months ago, she started her period. Trina and Natalee are concerned that her medication is no longer working with her change in hormones. Both report that her “mood has gone downhill.” She has been having trouble again in school and with her friends.

Recall that there is a history of depression in the family, as Natalee’s maternal grandmother and maternal aunt both have had major depression. Her maternal grandmother was hospitalized for psychiatric care 20 years ago for depression and a suicide attempt by an overdose of Tylenol.

Natalee Questions

From your perspective as Natalee’s psychiatric nurse practitioner, answer the following questions. Include at least two peer-reviewed, evidence-based references.

What screening tool(s) would you use during this interview?
What medication change(s) would you prescribe for Natalee and why? Please note the medication(s), initial dose, and dosing schedule.
Fill out a prescription (PDF) Links to an external site.for one medication. Print the template, fill it out, and scan it or take a photo. Attach the image to your post.
Identify whether your decision is FDA-approved or off-label; if off-label, explain why you chose this medication.
How do you educate and inform Trina about how this medication will work, side effects, and risks/black box warning(s) with this medication? How do you include Natalee in your conversation?

 

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